Examining health service utilization in the year prior to suicide death [poster]
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Background: Suicide is the 10th leading cause of death in the United States, warranting public health prevention efforts. Such efforts require accurate risk identification. However, the US Preventive Services Task Force has suggested that there is not enough information available to recommend screening for suicide risk in primary care. While research suggests that many individuals receive services before death, studies have been limited by small samples. This study used the largest US general population sample to date to examine the frequency, types and patterns of health services utilized prior to suicide as well as variations by subgroup. Methods: Health care utilization and demographic data from six health systems of the Mental Health Research Network were pre-matched with official mortality records and census files using the Virtual Data Warehouse. In total, 2237 suicide deaths were identified using ICD-10 codes, X60-X84. Reverse survival curves were calculated estimating weekly utilization for the year prior to death. These data were stratified by age, sex, insurance type, socioeconomic indicators, and cause of death. Results: Suicide death was more common among men (77%; n=1728) and occurred more frequently by violent means (77%; n=1730). Approximately 81% (n=1806) received services in the year before death, with nearly 40% (n=900) making a visit within a month before death. While 44% (n=992) made any visit that included a mental health diagnosis in the year before death, most visits occurred in primary care without a mental health diagnosis (59%; n=1320). Non-mental health primary care visits and outpatient behavioral health visits were most common in the two weeks before suicide. Service use occurred most often among women (87%; 441 of 509), older adults (65+ years; 96%; 386 of 401), and those who died by non-violent means (85%; 422 of 498). The relative frequency of mental health and general medical utilization differed markedly between age groups. Conclusions: Most individuals who died by suicide also used health services within a year before death. Here, over half of these individuals did not have a mental health diagnosis, and were seen for other reasons in primary care. This study may guide targeted public health prevention efforts, including risk identification strategies.